INTEGUMENTARY SYSTEM

O The integumentary system is the largest body system and includes the skin, O 5 strata:
or integument, and its appendages (the hair, nails, and certain glands).
1. Stratum Corneum – many layers of deep, squamous cells, the most
O The word integument means a covering. superficial ones slough off.
O Cutaneous membrane. 2. Stratum Lucidum – layer of dead, transparent cells
O 2 major layers: 3. Stratum Granulosum – cells filled with keratohyalin; cell death occurs
here.
O Epidermis (superficial layer)
4. Stratum Spinosum – keratinocytes to protect cells from UV rays,
O Dermis (deeper layer)
several layers of cells held together by many desmosomes.
5. Stratum Basale – innermost, contains melanocytes.
Functions of the SKIN
O Protection – protection against abrasion, UV light, bacterial and dehydration.
LAYERS OF EPIDERMIS
O Sensation – can detect heat, cold, touch, pressure, and pain.
O The stratum corneum, or horny layer, is the outermost layer and
O Thermoregulation – regulates temperature and controls blood flow consists of tightly arranged layers of cellular membranes and
keratin.
O Vitamin D production – skin produces molecule that transform into vitamin D O The stratum lucidum, or clear layer, blocks water penetration or
O Excretion – body waste like sweating loss. It may be missing in some thin skin.
O The stratum granulosum, or granular layer, is responsible for
keratin formation and, like the stratum lucidum, may be missing in
Epidermis some thin skin.
O The stratum spinosum, or spiny layer, also helps with keratin
O Stratified squamous epithelium. formation and is rich in ribonucleic acid.
O Keratinocytes - primary cells; 90% of epidermal skin cells. O The stratum basale, or the basal layer, is the innermost layer and
O Keratinization – process in producing protein produces new cells to replace the superficial keratinized cells that
➢ keratin - fibrous protein that makes epidermis a tough protective layer are continuously shed or worn away.
O Has 4 or 5 layers (“stratum/strata”) depending on body part
➢ Palms and soles have 5 layers
O Avascular.
O Keratinization LAYERS OF DERMIS
1. Transformation of living cells of the stratum basale into the dead The papillary dermis has fingerlike projections, papillae, that connect the dermis to
squamous cells of the stratum corneum the epidermis. It contains characteristic ridges that on the fingers are known as
fingerprints. These ridges also help the fingers and toes in gripping surfaces.
O Keratinized cells are filled with keratin and have a protein envelope, both of
which contribute to structural strength. The reticular dermis covers a layer of subcutaneous tissue. It’s made of collagen
fibers and provides strength, structure, and elasticity to the skin.
O Impermeability to water is due to the lipids in the intercellular spaces.
O Keratin:
HYPODERMIS
1. Soft keratin - present in skin and the inside of hairs
O Subcutaneous tissue.
2. Hard keratin - occurs in nails and the outside of hairs. Hard keratin
O The innermost (or deepest) and thickest layer of skin.
makes cells more durable, and these cells are not shed.
O Loose connective tissue that contains half of the body’s stored fat.
O Thick skin – has all five epithelial strata.
O Thin skin - contains fewer cell layers per stratum, and the stratum lucidum is
Skin Color
usually absent.
1. Melanin – dark pigments responsible for skin, hair, and eye color.
DERMIS
– mostly brown to black, but some are yellowish or reddish.
O The dermis, also called the corium, is the skin’s second layer.
O It’s an elastic system that contains and supports blood vessels, lymphatic – produced by melanocytes.
vessels, nerves, and the epidermal appendages.
➢ Melanocytes produce melanin inside melanosomes and then transfer
O Collagen and elastic fibers are responsible for the structural strength of the
the melanin to keratinocytes.
dermis.
O Has 2 layers: papillary dermis, and reticular dermis. ➢ The size and distribution of melanosomes determine skin color.
O Contains nerve endings, hair follicles, smooth muscles, glands and
lymphatic vessels 2. Carotene – yellowish pigment found in plants.
O Pacinian corpuscles – deep pressure – Gives the skin a slight yellowish tint.
O Meissner corpuscles – detecting simultaneous stimulation at two points on
the skin 3. Blood flow – blood flow increases it gives a reddish color.
O Ruffini end organs – sensing continuous touch or pressure – decrease of blood oxygen produces bluish color
O Cleavage or tension lines – orientation of elastic and collagen fibers in the
reticular layer. called cyanosis.
O Cyanosis – bluish skin color, may be due to decreased oxygen content in
blood.
FINGERPRINT
The friction ridges found on the surface of the epidermis.
The pattern of the dermal papilla forms the pattern of the friction ridges.

Accessory Skin Structures
HAIR – serves as mechanical protection or the skin, increases sensory
function n and aids in regulating body temperature.
O A hair has three parts: shaft, root, and hair bulb.
➢ Shaft – above the surface of the skin.
➢ Root – part of hair enclosed in follicle.
➢ Hair bulb – base of the hair root.
➢ Hair follicle – extension of the epidermis deep into the dermis, plays an
important role in tissue repair.
• Epidermal sheath- inner structure, composed of epithelial tissue;
forms the hair.
• Dermal sheath - outer structure, composed of dermal tissue,
supplies blood vessels to epidermal portion.
O The root and shaft of a hair are composed of dead keratinized epithelial cells.
O The hair bulb produces the hair in cycles, with a growth stage and a resting
stage.
O Lanugo (fetal hair) is replaced near the time of birth by terminal hairs (scalp,
eyelids, and eyebrows) and vellus hairs. At puberty, vellus hairs can be
replaced with terminal hairs.
Arrector Pili
• Associated with each hair follicle.
• Responsible for “goose flesh” or “goose bumps”.
• Located in the dermis attach to hair follicles, helping the shaft to stand and
trap air close to the epidermis for temperature control.
GLANDS
O Sebaceous glands
O Sudoriferous glands (Sweat glands)
Accessory Skin Structure: Sebaceous Glands
O Sebaceous glands produce sebum, which oils the hair and the surface of the
skin, rich in lipids, protects against some bacteria
O Found all over skin except palms of hand and soles of feet.
O Most are connected by a duct to the superficial part of a hair follicle.
Accessory Skin Structure: Sudoriferous glands
O There are two types of sweat glands: eccrine glands and apocrine glands.
O Are small tubular structures of the skin that produce sweat.
1. Eccrine (Merocrine) sweat glands (all over the body)
– glands located in almost every part of the skin.
– produce sweat, which cools the body.
– most numerous in the palms and soles.
– produces sweat once the body temperature rise.
2. Apocrine sweat glands (underarm and pelvic areas)
– produces thick secretion rich in organic substances that can be broken
down by bacteria to cause body odor.
– located in the axillary (underarm) and anogenital (groin/ pelvic) areas.
– Apocrine glands begin to function at puberty.
Other skin glands are ceruminous glands, which make cerumen (earwax), and
mammary glands, which produce milk.
NAILS
O The nails are situated over the distal surface of the end of each finger and
toe. Nails are composed of a specialized type of keratin.
O The nail root is covered by skin, and the nail body is the visible part of the
nail.
O Nearly all of the nail is formed by the nail matrix, but the nail bed contributes.
O The lunula is the part of the nail matrix visible through the nail body.
O The nail is stratum corneum containing hard keratin.
PARTS OF A NAIL
• Nail body – visible part of the nail.
• Nail root – part of the nail covered by the skin.
• Eponychium (cuticle) –skin that extends onto the nail body.
• Nail matrix - area where your fingernails and toenails start to grow.
• Nail bed – the pinkish-colored soft tissue underneath your nail plate (the hard
part of your nail).
• Lunula – small part of nail matrix, cresent-shaped area at the base of the nail.
BURNS
• Burns are tissue damage that results from heat, overexposure to the sun or
other radiation, or chemical or electrical contact.
• Partial-thickness burns (first- and second-degree burns), and full-thickness
burns (third-degree burn).
Classification:
• First-degree burn - only epidermis is damaged. (sunburn)
• Second-degree burn - epidermis and upper region of dermis is
destroyed; characterized by oozing blisters.
• Third-degree burn - destroy the entire thickness of skin and the under
lying tissue.
Wallance Rule-of-Nines - For rough estimation of the body surface area that is
affected by burn.
Some Common Disorders
• Acne - a skin condition that occurs when your hair follicles become plugged
with oil and dead skin cells.
• Allergic response - skin irritations that results to redness, itchiness, and
swelling that may progress into blisters.
• Warts are caused by human papillomavirus. The virus causes uncontrolled
growth of epidermal tissue. The virus is transmitted by direct contact with an
infected individual. The growths are usually benign and disappear
spontaneously. They can also be removed surgically or with topical
applications.
Skin Cancer
• Most common type of cancer.
• Development of skin cancer is often associated with exposure to ultraviolet
(UV) light from the sun.
• Mostly develop on the face, neck, or hands.

Types Skin Cancer

1. Basal Cell Carcinoma – most frequent skin cancer, begins with cells in the
stratum basale and extends into the dermis to produce an open ulcer.
2. Squamous Cell Carcinoma - second most common, first
dangerous type of skin cancer.
- If left untreated can metastasize, and cause death.
3. Malignant Melanoma – rare form of skin cancer that arises from
melanocytes, usually in a preexisting mole.
- most serious form of skin cancer.
 SKIN CONDITIONS/INJURIES Second degree Burn
WHAT IS A BURN? O This type of burn affects both the epidermis and the second layer of the skin
(dermis).
A burn is a tissue damage that results from heat, overexposure to the sun or other
radiation, or chemical or electrical contact. Burns can be minor medical problems or O It may cause swelling and red, white splotchy skin.
life-threatening emergencies.
O Blisters may develop, and pain can be severe.
O Deep second degree burns can cause scarring.
WHAT CAUSES BURNS?
O Should be assessed by a doctor for risk of infection.
Burns are caused by:
O A prescription medication may be required.
O Dry heat (such as fire), wet heat (such as steam or hot liquids).
O Thermal burns are the most common kind of burns. These burns occur when
flames, hot metals, scalding liquids, or steam come in contact with skin as a
result of many different circumstances, including house fires, vehicle Third degree Burn
accidents, kitchen accidents, and electrical malfunctions.
O This burn reaches to the fat layer of the
O Radiation, such as that from x-rays skin.
O Sunlight or other sources of ultraviolet radiation, such as tanning bed O If nerve damage has occurred, there may
not be any pain for it causes numbness.
O Chemicals such as strong acids, lye, paint thinner or gasoline.
O Signs include bleeding, appearing a bit
black, brown, or white; skin appears to be
SIGNS AND SYMPTOMS dry and leathery.
Burn symptoms may vary dependIng on how deep the skin damage is. It can take a O Needs immediate medical care.
day or two for the signs and symptoms of a severe
burn to develop.
First degree Burn
O This minor burn affects only the outer layer of the
skin (epidermis). It may cause redness and pain.
O May require medical help.
Fourth degree Burn O Do not open blisters until topical antimicrobials can be applied, such as by a
health-care provider.
O Most serious type of burn.
O Do not apply any material directly to the wound as it might become infected.
O Penetrate deeply beneath the skin.
O Avoid application of topical medication until the patient has been placed under
O There is potential for nerve damage and
appropriate medical care.
injury to deeper tissues including muscles,
tendons, and bones.
O Burns may appear yellow, white, brown, or SKIN CONDITIONS/INJURIES
blackened.
Impetigo
O Needs immediate medical care.
O bacterial infection
O one of the most common skin infections
Medical management among kids

What to do? O generally caused by one or two bacteria; Staphylococcus aureus or

O Stop the burning process by removing clothing and irrigating the burns.
O Extinguish flames by allowing the patient to roll on the ground, or by applying
a blanket, or by using water or other fire-extinguishing liquids.
O Use cool running water to reduce the temperature of the burn.
O In chemical burns, remove or dilute the chemical agent by irrigating with large
volumes of water.
O Wrap the patient in a clean cloth or sheet and transport to the nearest
appropriate facility for medical care.
What not to do?
O Do not start first aid before ensuring your own safety (switch off electrical
current, wear gloves for chemicals etc.)
O Do not apply paste, oil, haldi (turmeric) or raw cotton to the burn.
O Do not apply ice because it deepens the injury.
O Avoid prolonged cooling with water because it will lead to hypothermia.
Streptococcus pyogenes (also called group A streptococcus, which also
causes strep throat).
O usually appears as red sores on the face, especially around a child's nose
and mouth. The sores burst and develop honey-colored crusts.
Bullous Impetigo
• Small or large bullae arise over a short period of time, usually spreading
locally on the face, trunk, extremities, buttocks, or perineal regions and may
reach distal areas
• Bullae, which are less easily ruptured than in the non-bullous form, initially
contain clear fluid, which then becomes cloudy. Once ruptured, brown-yellow
crusts develop.
• Unlike with the non-bullous form, extension occurs with central clearing.
 CAUSES OF IMPETIGO
O Impetigo is caused by either:
O Staphylococcus aureus (S. Aureus)
O Streptococcus pyogenes (S. pyogenes)
O S. Aureus exists harmlessly on human skin.
O S. pyogenes is present in the normal mouth flora.
O You're exposed to the bacteria that cause impetigo when you come into
contact with the sores of someone who's infected or with items they've
touched — such as clothing, bed linen, towels and even toys.
Non Bullous Impetigo

RISK FACTORS OF IMPETIGO

O Age
O Crowded conditions
O Warm, humid weather
O Certain sports
O Broken skin
O Older adults and people with diabetes or a compromised immune system are
more likely to develop ecthyma, a deeper and more serious form of impetigo.

SYMPTOMS OF IMPETIGO
O red sores that quickly rupture.
O ooze for a few days
O form a yellowish-brown crust.
O The sores usually occur around the nose and mouth but can be spread to
other areas of the body by fingers, clothing and towels.
 O Ecthyma - penetrates deeper into the skin — causing painful fluid- or pus- Review
filled sores that turn into deep ulcers.
O Match the layer of the epidermis with the correct description or function:
1. Sloughing occurs; 25 or more layers of dead squamous cells.
MODE OF TRANSMISSION OF IMPETIGO
➢ Stratum Corneum
The organisms enter through damaged skin and are transmitted through direct
2. Production of keratin granules; cells die.
contact with patients or asymptomatic carriers. Nasal carriers are particularly likely
to transmit disease. The disease is rarely transmitted by indirect contact with ➢ Stratum Granulosum
objects.
3. Dispersion of keratohyalin around keratin fibers; layers appear translucent;
cells dead.
HOW TO AVOID IMPETIGO ➢ Stratum Lucidum
O Take a bath or shower regularly. 4. True or False: When skin appears blue (cyanosis), this indicates presence of
oxygenated blood.
O Use soap to keep your skin clean.
➢ False
O Watch out for skin that's scraped or irritated, like a mosquito bite. Keep those
areas clean and covered and don't scratch. 5. After birth, the type of hair on the scalp, eyelids and eyebrows is ___.
O Wash your hands regularly with soap. ➢ Terminal hair
O Keep your nails short and clean. 6. Glands that produce a white, oily substance; usually open into hair follicles.
➢ Sebaceous Glands
MEDICAL MANAGEMENT OF IMPETIGO
If you are diagnosed with impetigo, here are some treatment tips: Epidermis – epithelial tissue
O If the doctor prescribes antibiotics, be sure to take them for the full length of Dermis – connective tissue
time prescribed by the doctor. Otherwise, the infection can come back.
Eyelid – thinnest skin in the body
O Gently wash your skin several times a day with an antibacterial soap to
remove crusts and drainage. Try not to touch the rash. Erythema – reddish skin

O If you should accidentally touch it, be sure to wash your hands and the Hair matrix – it is where hair growth happens
exposed area with mild soap and water. Vellus hair – light pigmented hair
O If your child has impetigo, keep him or her away from other children until he or
she is treated.